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Veit JGS, Weidow M, Serban MA. A versatile, bioengineered skin reconstruction device designed for use in austere environments. Front Bioeng Biotechnol 2023; 11:1208322. [PMID: 37362212 PMCID: PMC10285514 DOI: 10.3389/fbioe.2023.1208322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
Austere environments in which access to medical facilities, medical personnel, or even water and electricity is limited or unavailable pose unique challenges for medical device product design. Currently existing skin substitutes are severely inadequate for the treatment of severe burns, chronic wounds, battlefield injuries, or work-related injuries in resource-limited settings. For such settings, an ideal device should be biocompatible, bioresorbable, promote tissue healing, not require trained medical personnel for deployment and use, and should enable topical drug delivery. As proof of concept for such a device, silk fibroin and an antioxidant hyaluronic acid derivative were chosen as primary constituents. The final formulation was selected to optimize tensile strength while retaining mechanical compliance and protection from reactive oxygen species (ROS). The ultimate tensile strength of the device was 438.0 KPa. Viability of dermal fibroblasts challenged with ROS-generating menadione decreased to 49.7% of control, which was rescued by pre-treatment with the hyaluronic acid derivative to 85.0% of control. The final device formulation was also tested in a standardized, validated, in vitro skin irritation test which revealed no tissue damage or statistical difference from control. Improved topical drug delivery was achieved via an integrated silk fibroin microneedle array and selective device processing to generate crosslinked/through pores. The final device including these features showed a 223% increase in small molecule epidermal permeation relative to the control. Scaffold porosity and microneedle integrity before and after application were confirmed by electron microscopy. Next, the device was designed to be self-adherent to enable deployment without the need of traditional fixation methods. Device tissue adhesive strength (12.0 MPa) was evaluated and shown to be comparable to a commercial adhesive surgical drape (12.9 MPa) and superior to an over-the-counter liquid bandage (4.1 MPa). Finally, the device's wound healing potential was assessed in an in vitro full-thickness skin wound model which showed promising device integration into the tissue and cellular migration into and above the device. Overall, these results suggest that this prototype, specifically designed for use in austere environments, is mechanically robust, is cytocompatible, protects from ROS damage, is self-adherent without traditional fixation methods, and promotes tissue repair.
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Affiliation(s)
- Joachim G. S. Veit
- Serban Lab, Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT, United States
- Montana Biotechnology Center (BIOTECH), University of Montana, Missoula, MT, United States
| | - Morgan Weidow
- Serban Lab, Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT, United States
| | - Monica A. Serban
- Serban Lab, Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, MT, United States
- Montana Biotechnology Center (BIOTECH), University of Montana, Missoula, MT, United States
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King B, Cancio LC, Jeng JC. Military Burn Care and Burn Disasters. Surg Clin North Am 2023; 103:529-538. [PMID: 37149388 DOI: 10.1016/j.suc.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Mass-casualty incidents can occur because of natural disasters; industrial accidents; or intentional attacks against civilian, police, or in case of combat, military forces. Depending on scale and type of incident, burn casualties often with a variety of concomitant injuries can be anticipated. The treatment of life-threatening traumatic injuries should take precedent but the stabilization, triage, and follow-on care of these patients will require local, state, and often regional coordination and support.
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Affiliation(s)
- Booker King
- North Carolina Jaycee Burn Center, University of North Carolina Chapel Hill, Burnett Womack Building, Campus Box 7206, Chapel Hill, NC 27599-7206, USA
| | - Leopoldo C Cancio
- U.S. Army Burn Center, U.S. Army Institute of Surgical Research, Fort Sam Houston, San Antonio, TX 78234-6315, USA
| | - James C Jeng
- University of California Irvine, 3800 West Chapman Avenue, Suite 6200, Orange, CA 92868, USA.
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Stewart BT, Nsaful K, Allorto N, Man Rai S. Burn Care in Low-Resource and Austere Settings. Surg Clin North Am 2023; 103:551-563. [PMID: 37149390 DOI: 10.1016/j.suc.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
More than 95% of the 11 million burns that occur annually happen in low-resource settings, and 70% of those occur among children. Although some low- and middle-income countries have well-organized emergency care systems, many have not prioritized care for the injured and experience unsatisfactory outcomes after burn injury. This chapter outlines key considerations for burn care in low-resource settings.
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Affiliation(s)
- Barclay T Stewart
- University of Washington, UW Medicine Regional Burn Center, Harborview Medical Center, Seattle, WA, USA.
| | - Kwesi Nsaful
- Department of Plastic, Reconstructive Surgery and Burns Unit, Ghana Navy, 37 Military Hospital, Accra, Ghana
| | - Nikki Allorto
- Head Pietermaritzburg Metropolitan Burn Service, Pietermaritzburg, KwaZulu Natal, South Africa
| | - Shankar Man Rai
- National Academy of Medical Sciences, Nepal Cleft and Burn Center at Kirtipur Hospital, Kathmandu, Nepal
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Williams JM, Ingle CL, Schauer SG, Maddry JK. Prehospital and Emergency Management. Surg Clin North Am 2023; 103:389-401. [PMID: 37149376 DOI: 10.1016/j.suc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Burn care in the prehospital and emergency settings requires rapid assessment of airway, breathing, and circulation. Intubation (if indicated) and fluid resuscitation are most important in emergency burn care. Total body surface area burned and depth of burn are important early assessments that help guide resuscitation and disposition. Burn care in the emergency department further includes carbon monoxide and cyanide toxicity evaluation and management.
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Affiliation(s)
| | | | - Steven G Schauer
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA; US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joseph K Maddry
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA; US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 59th Medical Wing, JBSA Lackland, TX, USA
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Convertino VA, Wagner AR, Akers KS, VanFosson CA, Cancio LC. Early identification of sepsis in burn patients using compensatory reserve measurement: A prospective case series study. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Ng M, Mark LKF, Fatimah L. Management of difficult intravenous access: a qualitative review. World J Emerg Med 2022; 13:467-478. [PMID: 36636560 PMCID: PMC9807392 DOI: 10.5847/wjem.j.1920-8642.2022.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/02/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND A perennial challenge faced by clinicians and made even more relevant with the global obesity epidemic, difficult intravenous access (DIVA) adversely impacts patient outcomes by causing significant downstream delays with many aspects of diagnoses and therapy. As most published DIVA strategies are limited to various point-of-care ultrasound techniques while other "tricks-of-the-trade" and pearls for overcoming DIVA are mostly relegated to informal nonpublished material, this article seeks to provide a narrative qualitative review of the iterature on DIVA and consolidate these strategies into a practical algorithm. METHODS We conducted a literature search on PubMed using the keywords "difficult intravenous access", "peripheral vascular access" and "peripheral venous access" and searched emergency medicine and anaesthesiology resources for relevant material. These strategies were then categorized and incorporated into a DIVA algorithm. RESULTS We propose a Vortex approach to DIVA that is modelled after the Difficult Airway Vortex concept starting off with standard peripheral intravenous cannulation (PIVC) techniques, progressing sequentially on to ultrasound-guided cannulation and central venous cannulation and finally escalating to the most invasive intraosseous access should the patient be in extremis or should best efforts with the other lifelines fail. CONCLUSION DIVA is a perennial problem that healthcare providers across various disciplines will be increasingly challenged with. It is crucial to have a systematic stepwise approach such as the DIVA Vortex when managing such patients and have at hand a wide repertoire of techniques to draw upon.
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Affiliation(s)
- Mingwei Ng
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Leong Kwok Fai Mark
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Lateef Fatimah
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
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Arnaudet I, Montassier E, Javaudin F, Naux E, Le Bastard Q. Prise en charge des brûlures en préhospitalier et aux urgences. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Une brûlure est une lésion de la peau ou d’un autre tissu organique principalement causée par la chaleur ou les rayonnements, la radioactivité, l’électricité, la friction ou le contact avec des produits chimiques. Les plus fréquentes, les brûlures thermiques (dues à la chaleur), surviennent lorsque certaines cellules ou toutes les cellules de la peau ou d’autres tissus sont détruites par des liquides bouillants, des solides chauds (brûlures de contact), ou des flammes. En France, l’incidence des brûlures prises en charge à l’hôpital est environ de 13 pour 100 000 habitants. La prise en charge en urgence du brûlé grave par lésion thermique est bien décrite, une recommandation de pratique professionnelle a été publiée en 2019 par la Société française d’anesthésie et de réanimation, en association avec la Société francophone de brûlologie, la Société française de médecine d’urgence et l’Association des anesthésistes-réanimateurs pédiatriques d’expression française. Pourtant, l’urgentiste va être confronté à de nombreuses brûlures de gravité et de nature différentes. Nous faisons ici une mise au point sur les données connues en termes d’épidémiologie, de manifestations cliniques et des différentes thérapeutiques qui peuvent être proposées dans la prise en charge des brûlures. Nous faisons aussi le point sur les localisations à risque particulier que l’urgentiste doit connaître, ainsi que sur les intoxications qui peuvent être associées aux brûlures. Nous détaillons aussi certains contaminants qui sont à connaître.
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Baird A, Serio-Melvin M, Hackett M, Clover M, McDaniel M, Rowland M, Williams A, Wilson B. BurnCare tablet trainer to enhance burn injury care and treatment. BMC Emerg Med 2020; 20:84. [PMID: 33126858 PMCID: PMC7602345 DOI: 10.1186/s12873-020-00378-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Applied Research Associates (ARA) and the United States Army Institute of Surgical Research (USAISR) have been developing a tablet-based simulation environment for burn wound assessment and burn shock resuscitation. This application aims to supplement the current gold standard in burn care education, the Advanced Burn Life Support (ABLS) curriculum. RESULTS Subject matter experts validate total body surface area (TBSA) identification and analysis and show that the visual fidelity of the tablet virtual patients is consistent with real life thermal injuries. We show this by noting that the error between their burn mapping and the actual patient burns was sufficiently less than that of a random sample population. Statistical analysis is used to confirm this hypothesis. In addition a full body physiology model developed for this project is detailed. Physiological results, and responses to standard care treatment, are detailed and validated. Future updates will include training modules that leverage this model. CONCLUSION We have created an accurate, whole-body model of burn TBSA training experience in Unreal 4 on a mobile platform, provided for free to the medical community. We hope to provide learners with more a realistic experience and with rapid feedback as they practice patient assessment, intervention, and reassessment.
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Affiliation(s)
- Austin Baird
- Applied Research Associates, Inc., 8537 Six Forks Rd, Raleigh, NC, 27615, USA.
| | - Maria Serio-Melvin
- USARMY Institute of Surgical Research, 3698 Chambers Pass Ste B JBSA ft. Sam, Houston, TX, 78234-7767, USA
| | - Matthew Hackett
- Army Research Laboratory, 12423 Research Pkwy, Orlando, FL, 32826, USA
| | - Marcia Clover
- Applied Research Associates, Inc., 8537 Six Forks Rd, Raleigh, NC, 27615, USA
| | - Matthew McDaniel
- Applied Research Associates, Inc., 8537 Six Forks Rd, Raleigh, NC, 27615, USA
| | - Michael Rowland
- USARMY Institute of Surgical Research, 3698 Chambers Pass Ste B JBSA ft. Sam, Houston, TX, 78234-7767, USA
| | - Alicia Williams
- USARMY Institute of Surgical Research, 3698 Chambers Pass Ste B JBSA ft. Sam, Houston, TX, 78234-7767, USA
| | - Bradly Wilson
- Applied Research Associates, Inc., 8537 Six Forks Rd, Raleigh, NC, 27615, USA
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McDaniel M, Baird A. A Full-Body Model of Burn Pathophysiology and Treatment Using the BioGears Engine. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:261-264. [PMID: 31945891 DOI: 10.1109/embc.2019.8857686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We have created a model of systemic burn pathophysiology by incorporating a mathematical model of acute inflammation within the BioGears Engine. This model produces outputs consistent with burns of varying severities and leverages existing BioGears functionality to simulate the effect of treatment on virtual patient outcome. The model performs well for standard resuscitation scenarios and we thus expect it to be useful for educational and training purposes.
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